Depression can leave you feeling hopeless or embarrassed. But help for depression is out there – including new medicines, talk therapies and natural remedies. Read on for key questions to ask your doctor for beating the blues...

When you’re depressed, just getting out of bed can be a struggle. And feelings of guilt and shame can be overwhelming.

But “you don’t have depression because you did something wrong,” says Gregory Simon, M.D., psychiatrist at Group Health Cooperative in Seattle and chair of the scientific advisory board at the Depression and Bipolar Support Alliance.

Discussing symptoms and treatments with a doctor or mental health professional is the first step to beating this disorder.

Here are the top questions to ask your doctor to get help for depression.

1. What causes depression?Scientists think this disorder is caused by a combination of genetics and stress, says Matthew Rudorfer, M.D., associate director for treatment research at the National Institute of Mental Health (NIMH) in Bethesda, Md.

People with depression have abnormal levels or functioning of the neurotransmitters serotonin, norepinephrine and dopamine, chemicals in the brain that affect mood.

Before puberty, the rate of depression is about the same in boys and girls. But depression is twice as common in women as in men, according to the National Alliance on Mental Illness (NAMI). As many as one in eight women experience depression in their lifetime.

2. Why does gender matter?Researchers aren’t sure. It may be due to hormones or life stresses, or because women are more likely to suffer physical and sexual abuse, explains Jennifer Payne, M.D., director of the Women’s Mood Disorders Center at Johns Hopkins Hospital in Baltimore, Md.

Serotonin and norepinephrine reuptake inhibitors (SNRIs), which raise both serotonin and norepinephrine levels. They include venlafaxine (Effexor), desvenlafaxine (Pristiq) and duloxetine (Cymbalta).

Norepinephrine and dopamine reuptake inhibitors (NDRIs), which increase both dopamine and norepinephrine levels. They’re sold under the brand name Wellbutrin (bupropion).

Mirtazapine (Remeron), which increases the activity of the brain circuits that react to neurotransmitters.

Aripiprazole (Abilify), an antipsychotic sometimes prescribed along with antidepressants to increase their effectiveness. It’s approved by the Food and Drug Administration for this use.

6. What if those medications don’t work?Your doctor may recommend two older types of drugs: tricyclic antidepressants (TCAs) or monoamine oxidase inhibitors (MAOIs).

Like SNRIs, TCAs increase serotonin and norepinephrine levels. This group includes amitriptyline (Elavil), amitriptyline and chlordiazepoxide (Limbitrol), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor, Aventyl) and protriptyline (Vivactil). But they can cause side effects including drowsiness and weight gain.

People who take them should avoid foods and drugs with high levels of the chemical tyramine, such as cheese, wine and pickles, and over-the-counter cold medicines and decongestants. Mixing MAOIs and tyramine causes high blood pressure and can lead to stroke.

7. How long will it take me to feel better?It can take weeks or months to feel the full effects, Dr. Payne says.

Early results of an ongoing, large-scale study by NIMH, called STAR*D, show it takes 6-8 weeks before antidepressants kick in.

But changes in medication and dosage can increase that period, says Dr. Payne.

For example, one-third of people in the STAR*D study who didn’t get better with a first treatment had all symptoms reduced with the addition of a second medication. Another one-fourth of patients improved when they switched medications.

8. Which side effects do I need to watch for?About half of people taking antidepressants report some side effects in the first weeks of treatment. Among the most common are nausea, diarrhea, headaches and decreased libido.

These issues may subside as you adjust to the medication, but tell your doctor about any unusual symptoms you notice. They can often be treated by changing the dose or medicines.

9. Can I drink when taking antidepressants?It's not advisable because alcohol can worsen side effects or decrease the drugs' effectiveness.

Also, since alcohol is a central nervous system depressant, it slows brain activity. This decreases anxiety, but can also lead to greater feelings of depression, says Michelle Riba, M.D., professor at the University of Michigan Depression Center in Ann Arbor.

And alcohol interferes with sleep, which exacerbates depression.

Still, moderate alcohol use is OK for some people with depression, says Dr. Rudorfer.

Your weight and age can affect your response to alcohol, so it's best to consult your doctor about how often and how much you can drink. “It’s important to tailor it to your own circumstances,” Dr. Riba says.

10. How does therapy help?“The chemical changes in the brain that cause depression create negative thought patterns. One way to change those is with psychotherapy” Dr. Riba says.

Some psychiatrists practice psychotherapy, but you can also see a psychologist or social worker. Plan on weekly sessions if you can afford it.

11. What type of therapy should I look for?Two types of therapy are especially helpful in treating depression: cognitive behavioral therapy and interpersonal therapy.

12. How long will I need therapy? Working together, you and your therapist should determine how long to continue.

“When people are depressed, they usually develop other issues,” Dr. Rudorfer says. “Their relationships are affected, or they may be having problems at work.”

Over time, a good therapist will help you develop coping skills so you can deal with typical life stressors without triggering your depression, Dr. Rudorfer says. (For more on how to handle tough times, read 6 Ways to Ward Off Depression.)

13. Are alternative treatments effective?A recent study by a task force of the American Psychiatric Foundation found that alternative treatments for depression had promising results and should be studied further to determine their effectiveness and safety.

The more promising treatments include:

Omega-3 fatty acids: A supplement that seems beneficial when used with antidepressants, but not as the sole treatment for depression.

St. John's wort (hypericum): An herbal dietary supplement most effective for mild to moderate depression, less so for severe depression. However, it may interfere with medications used to treat heart disease, depression, seizures, cancers and organ transplant rejection, as well as oral contraceptives.

Folate (folic acid): A seemingly effective and well-tolerated B vitamin; it hasn’t been adequately tested for correct dose and form.

S-adenosyl-L-methionine (SAMe): A supplement for treating major depression with low risk of side effects.

Light therapy (also known as phototherapy): Most effective for seasonal depression. For major depression, it may be useful when combined with an antidepressant.

14. What lifestyle changes should I make to manage my condition?Avoid drinking too many caffeinated beverages, because they can trigger anxiety.

Add aerobic exercise or resistance training to your workout routine.

An APA task force reviewed several depression studies and found that “patients who continued to exercise following study participation had a lower risk of relapse over several months to years.”

This was especially true for those who exercised from 180-210 minutes a week; they showed a 47% reduction in symptoms.

15. How should I explain my depression to family and friends? Patients with the best recovery rates have good support and involvement from loved ones, Dr. Payne says. “It’s important for them to understand this is a chemical disorder in your brain that requires medication.”

She suggests bringing a close friend or family member to a doctor’s appointment, or asking your doctor to hold a family meeting.

Could You Be Depressed?Depression affects 20 million people in any given year and is a serious enough disorder to compromise one's ability to function normally day to day. Find out if you're just blue or if you might be clinically depressed.

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